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(please print and submit)
Permission is hereby granted to Second Cinema to videotape and/or cablecast the following:
Project Title________________________________________
Event________________________________________________
Personality__________________________________________
Questions regarding the project listed above should be addressed to:
Producer: _______________________________________
Address: _______________________________________
Phone: _________________________________________
I have made all appropriate arrangements with and have obtained all clearances from broadcast stations, networks, sponsors,
music licensing organizations, performers (or their representatives), organizations, guests, and without limitations from
the foregoing any and all persons as may be necessary to transmit my program material over the facilities of Time Warner Cable.
Signature________________________________ Date__________
All submissions can be mailed (along with the indemification and release forms) to the following address:
Second Cinema
c/o Time Warner Cable
708 East Club Blvd.
Durham, NC 27704
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